Application for Plan Examination Site Development Permit

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Application for Plan Examination Site Development Permit Powered By Docstoc
					                                  Engineering Department                                Ph: 636-477-6600, Ext. 1670 (AT&T)
                                  St. Peters City Hall                                  Ph: 636-278-2244, Ext. 1670 (Century Tel)
                                  One St. Peters Centre Boulevard                       Fax: 636-477-9077
                                  St. Peters, MO 63376                        
                                                                                                                                            Permit # _____________

                        Application for Plan Examination & Site Development Permit
          Development Name:



          Address:                                                                   City:                                       State:                 Zip:

          Contractor:                                                                Phone:                                      Email:

          Address:                                                                   City:                                       State:                  Zip:

          Permission is requested to:

    Type of Improvement:                                                                       Attachment(s):
           Grading                              Storm Sewer Line                                   Plans/Prints
           Street                               Utility Excavation                                 Hydraulic Calculations
           Water Line                           Curb Cut/Driveway                                  Service Extension Agreement
           Sanitary Sewer                       Other:____________                                 Other:__________________________________
           Line                                                                                          __________________________________

    Pursuant to the above application, permission is granted under the following conditions:
    Any person violating any of the following conditions or willfully failing to comply with the requirements of same, shall be subject to forfeiture of their bond placed with
    the City of St. Peters.
    a.   Inspection fee shall be paid to the City of St. Peters.
    b.   Failure to notify the City 24 hours prior to construction can result in a stop-work order and revocation of this permit.
    c.   A protective lane for traffic shall be provided at all times.
    d.   All evacuated areas beneath and within two feet of the pavement shall be backfilled with Granular Material and compacted to 90% maximum density as determined by
         the "Modified AASHO T-180 Compaction Test" (ASTM D-1557-70). All other areas may be backfilled with excavated material placed in the 8" maximum thickness
         lifts, free of frozen particles, and compacted to 90% of maximum density as determined by ASTM D-1557-70.
    e.   The City's Water Department shall be notified of any connections to the existing system.
    f.   All sanitary precautions shall be taken in the handling of the water main when it is exposed. Chlorination of the exposed main shall be verified and appropriate contact
         time insured prior to flushing of the main. This sterilization process will be rigidly enforced.
    g.   Pressure tests of any new water mains shall be accomplished and verified prior to permitting water to flow from the City's water system and making any service taps to
         said mains.
    h.   If more than one (1) acre of grading is involved, a NPDES permit must be obtained from the Missouri Department of Natural Resources (MDNR).
    i.   Contact Missouri One-Call System, Inc. before any excavation begin; however, just contacting Missouri One-Call System does not relieve the contractor from their
         responsibility of checking with the Recorder of Deeds for owners/operators of all underground utilities in the area.
    j.   Street construction requires notification when street is within two feet of subgrade. Inspection and approval of subgrade of all streets shall be accomplished before
         placement of sub-base.

I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as his authorized agent, and
we agree to conform to all applicable laws of this jurisdiction.

Name (Please Print):

Signature of Applicant:                                                                                                Date: